Dr. William Wierda Discusses Diagnosing CLL

William G. Wierda, MD, PhD, associate professor, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the standard diagnostic workup for patients with chronic lymphocytic leukemia (CLL), a type of leukemia that is characterized by lymphocyte overproduction.

The first step in the examination of a potential patient with CLL is to send a blood sample for flow cytometry (FCM). The results of this test will help characterize the lymphocyte population. Initially patients will be referred after a blood count has demonstrated elevated white cells or unusually high lymphocytes; FCM checks if these cells are neoplastic.

CLL cells are generally monoclonal and express CD5, CD19, and CD23. The identification of these markers is required to make a diagnosis. The use of fluorescent in situ hybridization is not needed to make a diagnosis and can be reserved until later to detect prognostic markers.

Prognostic factors are informative and helpful for counseling the patients and determining the frequency of follow up after diagnosis. However, in the watch and wait phase the prognostic factors supply additional information that isn't primarily used to manage patients.